Obstetric management of 219 infants with hypoplastic left heart syndrome

Reis, Pedro; Punch, Margaret R.; Bove, Edward L.; Ven, Cosmas J. M. van de

doi:10.1016/s0002-9378(98)70123-1

Cited by 27 publications

(16 citation statements)

References 22 publications

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“…Therefore, a policy of close monitoring with transfer of care to a centre in the late third trimester is justified to avoid risks of ex‐utero transfer. In accordance with Reis et al, babies with functionally UVH tolerate labour well and vaginal delivery was achieved in about 50%, which is slightly less than the reported 73% by Brackley et al …”

Section: Discussionsupporting

confidence: 85%

Prenatal diagnosis of functionally univentricular heart, associations and perinatal outcomes

et al. 2016

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Section: Discussionsupporting

confidence: 85%

Prenatal diagnosis of functionally univentricular heart, associations and perinatal outcomes

et al. 2016

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“…Although certain congenital malformations, such as sacrococcygeal tumor or myelomeningocele, may be indications for a cesarean delivery [16], no evidence shows that the fetus with CHD has a higher risk of intrapartum fetal distress favoring the routine practice of cesarean delivery [14, 21, 26]. Whenever possible, our fetal care center encourages vaginal delivery, as reflected in the findings of our study.…”

Section: Discussionmentioning

confidence: 72%

Prenatal Diagnosis of Congenital Heart Disease and Birth Outcomes

et al. 2012

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This study was undertaken to examine the impact that prenatal diagnosis of congenital heart disease (CHD) has on birth and early neonatal outcomes. The prevalence of prenatally diagnosed CHD has risen over the past decade, but the effect that prenatal diagnosis of CHD has on peripartum decisions remains unclear. No consensus exists on the effect of prenatal diagnosis on neonatal outcomes. Between January 2004 and July 2009, a retrospective chart review of all neonates with CHD admitted to our institution’s neonatal intensive care unit was conducted. Obstetric and postnatal variables were collected. Among the 993 subjects, 678 (68.3 %) had a prenatal diagnosis. A prenatal diagnosis increased the odds of a scheduled delivery [odds ratio (OR) 4.1, 95 % confidence interval (CI) 3.0–5.6] and induction of labor (OR 11.5, 95 % CI 6.6–20.1). Prenatal diagnosis was not significantly associated with cesarean delivery when control was used for maternal age, multiple gestation, and presence of extracardiac anomaly. Mean gestational age had no impact on prenatal diagnosis, but prenatal diagnosis was associated with increased odds of delivery before a gestational age of 39 weeks (OR 1.5, 95 % CI 1.1–1.9) and decreased odds of preoperative intubation (OR 0.5, 95 % CI 0.3–0.6). Prenatal diagnosis did not have an impact on preoperative or predischarge mortality. Prenatal diagnosis was associated with increased odds of a scheduled delivery, birth before a gestational age of 39 weeks, and a decreased need for invasive respiratory support. Prenatal diagnosis of CHD was not associated with preoperative or predischarge mortality.

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“…12,13 Depending on the severity of the cardiac lesion, the fetus may be unable to tolerate the stress of labor or may need urgent cardiovascular surgery. As the optimal mode of delivery in these complex pregnancies is still unknown, scheduled cesarean delivery (CD) for the indication of fetal cardiac anomalies is being performed.…”

Section: Introductionmentioning

confidence: 99%

Neonatal outcomes in fetuses with cardiac anomalies and the impact of delivery route

Parikh

Grantz

Iqbal

et al. 2017

American Journal of Obstetrics and Gynecology

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BACKGROUND Congenital fetal cardiac anomalies compromise the most common group of fetal structural anomalies. Several previous reports analyzed all types of fetal cardiac anomalies together without individualized neonatal morbidity outcomes based on cardiac defect. Mode of delivery in cases of fetal cardiac anomalies varies greatly as optimal mode of delivery in these complex cases is unknown. OBJECTIVE We sought to determine rates of neonatal outcomes for fetal cardiac anomalies and examine the role of attempted route of delivery on neonatal morbidity. STUDY DESIGN Gravidas with fetal cardiac anomalies and delivery >34 weeks, excluding stillbirths and aneuploidies (n = 2166 neonates, n = 2701 cardiac anomalies), were analyzed from the Consortium on Safe Labor, a retrospective cohort study of electronic medical records. Cardiac anomalies were determined using International Classification of Diseases, Ninth Revision codes and organized based on morphology. Neonates were assigned to each cardiac anomaly classification based on the most severe cardiac defect present. Neonatal outcomes were determined for each fetal cardiac anomaly. Composite neonatal morbidity (serious respiratory morbidity, sepsis, birth trauma, hypoxic ischemic encephalopathy, and neonatal death) was compared between attempted vaginal delivery and planned cesarean delivery for prenatal and postnatal diagnosis. We used multivariate logistic regression to calculate adjusted odds ratio for composite neonatal morbidity controlling for race, parity, body mass index, insurance, gestational age, maternal disease, single or multiple anomalies, and maternal drug use. RESULTS Most cardiac anomalies were diagnosed postnatally except hypoplastic left heart syndrome, which had a higher prenatal than postnatal detection rate. Neonatal death occurred in 8.4% of 107 neonates with conotruncal defects. Serious respiratory morbidity occurred in 54.2% of 83 neonates with left ventricular outflow tract defects. Overall, 76.3% of pregnancies with fetal cardiac anomalies underwent attempted vaginal delivery. Among patients who underwent attempted vaginal delivery, 66.1% had a successful vaginal delivery. Women with a fetal cardiac anomaly diagnosed prenatally were more likely to have a planned cesarean delivery than women with a postnatal diagnosis (31.7 vs 22.8%; P < .001). Planned cesarean delivery compared to attempted vaginal delivery was not associated with decreased composite neonatal morbidity for all prenatally diagnosed (adjusted odds ratio, 1.67; 95% confidence interval, 0.85–3.30) or postnatally diagnosed (adjusted odds ratio, 0.99; 95% confidence interval, 0.77–1.27) cardiac anomalies. CONCLUSION Most fetal cardiac anomalies were diagnosed postnatally and associated with increased rates of neonatal morbidity. Planned cesarean delivery for prenatally diagnosed cardiac anomalies was not associated with less neonatal morbidity.

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Obstetric management of 219 infants with hypoplastic left heart syndrome

Cited by 27 publications

References 22 publications

Prenatal diagnosis of functionally univentricular heart, associations and perinatal outcomes

Prenatal diagnosis of functionally univentricular heart, associations and perinatal outcomes

Prenatal Diagnosis of Congenital Heart Disease and Birth Outcomes

Neonatal outcomes in fetuses with cardiac anomalies and the impact of delivery route

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